Sustained oral treatment with beta blockers has been shown to improve symptoms in patients with chronic heart failure. In non-placebo-controlled trials, the administration initially of a low dose, gradually increased over a period of weeks has been demonstrated to improve both symptoms, exercise capacity and left-ventricular ejection fraction. The rationale for this treatment is the enhanced adrenergic stimulation present in heart failure which results in decreased sensitivity and density of myocardial β-receptors. Beta blockers may decrease this pathological adrenergic drive. Carvedilol, in addition to its beta-blocking properties, is a vasodilator and is theoretically more suitable than earlier compounds of its potential to further decrease left-ventricular afterload. Recent studies have demonstrated symptomatic improvement with carvedilol in patients with heart failure, and a multicentre trial has been designed to evaluate its efficacy and safety.
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